Provider Demographics
NPI:1669540407
Name:MARTIN, JANE K (LIC AC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:K
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WELLESLEY ACUPUNCTURE CENTER
Mailing Address - Street 2:148 LINDEN STREET - #104
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482
Mailing Address - Country:US
Mailing Address - Phone:781-239-9977
Mailing Address - Fax:
Practice Address - Street 1:WELLESLEY ACUPUNCTURE CENTER
Practice Address - Street 2:148 LINDEN STREET - #104
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482
Practice Address - Country:US
Practice Address - Phone:781-239-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA462171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist